<form id="{$form.name}" name="{$form.name}">
{literal}
<style>
.lic_code{
width:400px;
height:100px;
border:1px solid #cccccc;
padding:10px;
color:#666666;
}

</style>
{/literal}
<div style="float:left; width:120px; height:400px;">
</div>
<div style="float:left; width:620px; height:400px;">
	<div style="height:75px;"></div>
	<div style="height:35px;">
		<div style="float:left; width:50px;"><img src="{$image_url}/icon_info.gif" /></div>
		<div style="float:left"><h1>{$form.title}</h1></div>
	</div>
	<div style="height:10px;"></div>
		<p class="input_row" style="height:45px; line-height:20px;">
		<label style="width:40px; height:90px;"></label>
		<span>{$form.description}</span></p>

<div>
{$dataPanel.fld_license_code.element}
</div>

		<div style="height:10px;"></div>
		<p class="input_row">
			<label style="width:40px; text-align:right"></label>
			{foreach item=elem from=$actionPanel}
				{$elem.element}
			{/foreach}
		</p>
</div>
</form>